Baptist Health System announced this week that 200 jobs will be eliminated at the Jackson, MS health system as part of a cost-cutting strategic overhaul that comes with a weak economy, falling admissions, and anticipated lower Medicare reimbursements.
Baptist Health Spokesman Robby Channell said the cuts and restructuring are being implemented after four month-long top-to-bottom review of BHS operations that have identified about $16 million in savings, about $13 million of which will come through renegotiating supply contracts and system efficiencies.
"We have to look at how to do things differently, spending less and doing more with less," Channell says. "Really, we're just trying to plan for the future. We hadn't sat back and looked at off of that until the last year or so."
Of the 200 jobs slated for elimination, 186 are now filled, including 50 nursing positions. However, Channell says the strategic review also identified another 136 jobs that were deemed to be necessary and would have to be filled, including 49 vacant nursing positions. Channell said BHS anticipates that many of the laid-off workers will reapply for the newly identified jobs.
Channell says that BHS employees were told when the review began that it might result in job losses. "They knew this was coming. We've been communicating with employees throughout this process," he says.
In addition, Baptist is relocating its Pediatric Outpatient Services away from the 640-bed Baptist Medical Center and to its Same Day Surgery Unit, to account for declining inpatient pediatric admissions.
Cambridge Health Alliance CEO Dennis D. Keefe says the nonprofit health system is reviewing legal options in the wake of a state labor board ruling that struck down CHA's unilateral cuts to health benefits for retired nurses at Cambridge Hospital.
Massachusetts' Commonwealth Employment Relations Board ruled that CHA violated state labor laws and failed to demonstrate sufficient financial need when it declared an impasse in negotiations and cut health benefits for retired nurses by 40%. The unilaterally imposed cuts raised retirees' share of health insurance to 50%, up from 10%.
"We continue to believe our negotiations with the Massachusetts Nurses Association, which represents the Cambridge Hospital nurses, were conducted fairly and with proper consideration," Keefe said in a media release following Friday's ruling by CERB.
Keefe says CHA imposed the cuts at a time when some private and government entities were shelving pensions and retiree health plans and abandoning former employees. "We wanted to retain a fair benefit. We feel that providing 50% of a retiree's healthcare costs is a reasonable and affordable offer to our public employees," he said.
MNA called the ruling "a complete victory" for nurses at Cambridge Hospital, saying CERB "flatly rejected the hospital's claim that it was eligible for an exception in this particular case, due to 'externally imposed' and 'economic' circumstances beyond their control."
CERB ordered CHA to post a notice to employees stating that it had violated state labor laws, and that the health system is taking corrective action that includes:
Restoring all terms of retirees health insurance benefits for all MNA members that were in effect before CHA made the cuts.
Participating in good faith collective bargaining that includes mediation, fact-finding, or arbitration.
Making whole employees for economic losses suffered from CHA's cuts.
"We are thrilled and vindicated by the board's ruling," says Betty Kaloustian, a nurse at Cambridge Hospital and chair of the nurses' local bargaining unit. "The board got it right. Our employer had an obligation to negotiate with us and they chose not to. Unfortunately, the hospital's actions have had a devastating impact on those nurses who they were trying to force to retire, not to mention the impact on all the other nurses who were seeing their benefit slashed. We are appalled at the lack of respect shown to those nurses who have given their heart and soul to this institution."
MNA Executive Director Julie Pinkham says state labor laws "couldn't be more clear on this point, and we are amazed that this public employer tried to claim otherwise."
"While this case is settled, we can only hope those who made these unlawful decisions are held accountable for the financial cost involved in creating this crisis, as well as for the impact these actions will have on the nurses' trust in the CHA administration going forward," Pinkham says.
Keefe believes CHA's record deficit in 2009 and other pressures on the public safety net hospital "were conclusive and compelling evidence of the serious economic threat under which we are operating."
In the last two years, he said, CHA has closed six health centers, all inpatient services at Somerville Hospital, inpatient pediatric services, 35 adult psychiatric beds, and ceased offering inpatient addictions services. "In doing so, we have had to reduce our work force by 450 full-time employees. That just gets us to where we are today: still confronting the forces of a deteriorating economy and a healthcare environment that is experiencing declining volumes, shrinking reimbursement, and continuing pressures from state and federal health care reform," Keefe said. "If this does not meet the definition of financial exigency, I'm not sure what would."
The CERB ruling doesn't change the financial facts for CHA, Keefe says.
"Unlike municipalities, we don't have taxing authority and cannot raise revenues to cover massively rising costs," he adds. "While we remain ready and eager to return to the bargaining table and develop a mutually agreeable labor contract, we need to be clear that the MNA's rejection of CHA's reasoned proposal threatens CHA's future."
The California Nurses Association has raised troubling accusations of ethnic discrimination against Sutter Health's California Pacific Medical Center and St. Luke's Hospital in San Francisco.
The union alleges that CPMC and St. Luke's Hospital are "engaged in systematic discrimination against the hiring of Filipino registered nurses." CNA leaders, flanked by Filipino community leaders, made the accusations during an Aug. 19 press conference.
CNA Co-president Zenei Cortez, RN, said that St. Luke's and CPMC RNs, many of them Filipino, have been outspoken in defense of their patients, and in opposition to Sutter and CPMC's plans to reduce services to the largely lower income, minority community depending on St. Luke's.
"Rather than respond to the concerns of the community, CPMC and Sutter have chosen instead to retaliate by carrying out a punitive, illegal, and immoral campaign of discrimination," Cortez said. "There can be no excuse for racial or ethnic discrimination. A hospital should be a center of therapeutic healing for patients, not a model of bigotry."
CNA on Aug. 18 filed a class-action grievance against Sutter and CPMC for contract violations in a "systematic policy of discrimination." CNA also called on Sutter Health to direct CPMC to end the discrimination. The union asked for an investigation by the San Francisco Human Rights Commission.
CPMC CEO Warren Browner, MD, called the accusations "false and designed to cover up the union's own failure to win a contract despite three years of negotiations."
"We pride ourselves on our diverse hiring policies and our longstanding commitment to promoting equal opportunity employment," Browner said. "The allegations of discrimination made by the California Nurses Association are dishonest and without merit."
The CNA made its case in the court of public opinion with written statements from former employees. Chris Hanks, a former director of Critical Care Services at CPMC, alleged that Diana Karner, the Sutter West Bay vice president of nursing told him several times, "you are not to hire any Filipinos."
CNA said CPMC hiring data supports the accusations. "A review by CNA of active employee lists provided by CPMC demonstrates that in early 2008 there was a major demographic shift among the nurses being hired at St Luke's. Before February 2008, 65% of St Luke's RNs were Filipino. After February 2008, only 10% of RNs hired were Filipino," CNA said.
Browner said the hospital's data tells a different story. "In 2007, 63% of our nurses at St. Luke's were Asian. Today that number is 66%," he said. "We do not have any way of identifying what percentage of our nurses are Filipino because we don't break down these categories by ethnicity or country of origin."
The CNA's discrimination claims are questionable, however, owing to issues that the union must have known about but failed to mention.
First, the United States reportedly has a seven-year backlog of work visa applications from foreign-trained healthcare professionals, including Filipino nurses. Assuming that CNA's hiring data from St. Luke's is accurate, it seems highly likely that any decrease in the number of Filipino nurses hired is owing more to this backlog, which is well beyond the control of any hospital, than to discrimination.
Second, a big critic of extending work visas for foreign-educated nurses—including Filipinos—is the American Nurses Association, the nation's largest professional trade association for RNs, and a one-time affiliate with CNA.
In fairness to ANA, their opposition is not based on discrimination. "We need to be dealing with our domestic healthcare workforce problem. We shouldn't be using immigration as a means to address the nursing shortage," Cheryl Peterson, ANA's director of nursing practice and policies, told HealthLeaders Media. "That being said, we do believe that nurses and other healthcare workers have the right to migrate and we benefit when they migrate and work here."
The fact is, with the ongoing economic doldrums, Peterson said, "nobody is bringing nurses in. The whole recruiting of foreign-educated nurses is bolloxed up because of the economy and also because of the availability of visas."
As jurors in the court of public opinion, here is where we stand: CNA wants us to believe that two major hospitals in one of the most liberal, ethnically diverse, and politically correct cities in the United States are engaged in "systematic discrimination" against an ethnic minority because a subset of workers from that group allegedly criticized the hospital.
CPMC wants us to believe that the accusations are a red herring designed to distract rank-and-file members from the union leadership's failure in contract talks. One side is fabricating. Who sounds more believable?
If the CNA's accusations are shown to be true, they will raise serious questions about the judgment and fitness of the executive leadership at CPMC. If the accusations are shown to be false, they will raise serious questions about the judgment and fitness of the executive leadership at CNA.
The Food and Drug Administration has approved a radio-frequency identification tool that tracks instruments and sponges during surgical procedures.
ORLocate, developed by Maumelle, AR-based Haldor Advanced Technologies Ltd., provides:
Anytime initial counts and item additions
The number of items missing
The number of clean and soiled sponges
The time of the last count.
The system uses radio-frequency identification to help surgical teams reduce the number of items left in patients during operations, and is designed to improve patient safety and decrease complex and time-consuming counting procedures that are prone to human error. ORLocate is the only RFID-based system that counts sponges and surgical instruments, Haldor says.
“Surgical teams must rely today on manually counting surgical items to ensure that sponges and instruments are not left in patients,” says Jacob Poremba, president/CEO of Haldor USA Inc. “This leaves enough room for errors, causing large hospitals to experience about two to four cases annually of a surgical item left inside a patient after surgery.”
More than a third of all retained surgical items are instruments (52% radiopaque sponges and 43% instruments), according to a 2007 study in the Journal of Surgical Research. Correcting such errors adds about $2 billion each year to the nation's medical bill.
ORLocate tested 99.8% accurate when counting and monitoring the location of sponges and instruments during lab testing by NAMSA in Northwood, OH, and labs in Germany and Israel. ORLocate tags each item used in surgery with a unique RFID identity. The tag is about the size of a hearing aid battery. The tagged instruments and sponges are detected via antennas located throughout the sterile field and software that continuously and automatically performs the counting.
Before procedures, a count of items is registered, and as they are used, the information is logged electronically. Before the procedure is completed, ORLocate has accounted for each item to ensure the safety and wellbeing of the patient, while increasing efficiency of operating room logistics and workflow processes.
The RFID technology allows ORLocate to:
Provide a complete and integrated solution to help reduce cases of retained surgical items in patients’ bodies.
Combine tracking technology and asset management services.
Potentially increase efficiency of operating room logistics and workflow processes.
Reduce time-consuming counting and inventory management.
Enable simple and accurate packing of surgery sets in the sterile processing department. .
Marin General Hospital Corp. has filed a suit against Sutter Health Corp. to recover more than $120 million that Marin claims Sutter improperly took from hospital's accounts for four years.
The suit alleges that since 2006, Sutter removed more than $30 million a year from Marin General's reserves, moving the money into Sutter accounts for its own benefit. In the five years before that, Sutter had made "cash sweeps" of less than $3 million a year.
"Sutter utterly ignored its fiduciary responsibility to Marin General and instead chose to line its own pockets with the hospital's reserves," says James J. Brosnahan, senior partner at Morrison & Foerster, the lead litigation attorney for the Marin General board. "It's improper, immoral and reprehensible conduct by a company that was trusted to manage this vital community resource."
Kathie Graham, communications and public affairs director for Sutter Health's West Bay Region, says she couldn't specifically comment on the suit because Sutter hasn't reviewed the allegations. "However, we can say that it is indeed regrettable that the Marin Healthcare District has elected to pursue legal action as there is no basis whatsoever for any such action," she added.
"Sutter Health complied in all respects with the legal agreements governing the transfer of Marin General Hospital and expended considerable resources above and beyond what we were required to do so as to ensure a smooth transition of the hospital. We have responded to the District's concerns throughout the transition and have explained our financial policies to the satisfaction of the regulatory agencies that govern non-profit healthcare entities. While we had hoped to put the contentious relationship of the past behind us, Sutter Health will now vigorously defend itself and will likewise vigorously pursue all claims against the Marin Healthcare District."
The alleged behavior detailed in the lawsuit, filed Thursday in Superior Court in Marin County, began when Sutter Health Corp. sought to end its 20-year management contract with Marin General five years early. After agreeing to a 2010 termination, Sutter began the massive cash transfers and sought to undermine Marin General as a future competitor, the suit alleges.
"Sutter asked Marin General for a 'divorce' and then decided they'd just clean out the bank account before the divorce became final," Brosnahan says. "The Board has worked for months to get Sutter to return the $120 million that doesn't belong to them, and time and again they have refused. Now they will have to explain to a judge and jury this massive wealth transfer and conflict of interest."
Sutter's improper and intentional actions depleted the reserves required to invest in the long-term future and continued modernization of the community's major hospital and its only trauma center, Marin General alleges.
"This action is not about money, but what that money represents: The ability for us to provide for the future health and welfare of Marin General Hospital and the people of Marin County," says Tim Sowerby, MD, of the Marin General Hospital Board. "The board has a fiduciary responsibility to recover the money Sutter took to fund fully our reserves—the down payment on the Hospital's future. That will enable Marin General to continue offering the community the highest level of healthcare and the most modern facility today and into the future."
Marin General alleges that Sutter removed the more than $120 million by creating a conflicted hospital governing board that included Sutter employees, who were paid by Sutter and depended for their livelihood and career advancement on Sutter management, and others who would follow Sutter's direction.
The Sutter board allegedly had detailed knowledge of the huge sums of cash taken by Sutter—including exact amounts—and the effect the removal of this money had on Marin General's finances. Because of the clear conflict of interest, however, the board never discussed or questioned the appropriateness of Sutter seizing this money, despite the damage being done to Marin General, Marin General alleges in its suit.
While Sutter was allegedly removing millions from Marin General, it also was investing millions in active healthcare operations in Marin County, in direct competition with Marin General and in violation of its agreements. Sutter sought to lease most of the available medical office space in close proximity to Marin General, refused to recruit physicians for Marin General, purchased a plot of land for new Sutter healthcare facilities, and even forced Marin General to pay for Sutter's pension obligations, Marin General alleges.
HealthSpring, Inc. announced Friday that it will pay $545 million to purchase Bravo Health, Inc., a privately held operator of Medicare Advantage plans in Pennsylvania, the Mid-Atlantic region, and Texas, and Medicare Part D stand-alone prescription drug plans in 43 states.
The deal creates the largest company in the nation focused solely on the Medicare Advantage population, including the seventh-largest Medicare Advantage plan, and the ninth-largest stand-alone prescription drug plan.
Bravo Health's August 2010 plan payment reports reflected aggregate Medicare Advantage and PDP membership of over 100,000 and 290,000, respectively. For the first six months of 2010, Bravo Health generated premium revenue of approximately $832.8 million.
"I cannot think of a better way to demonstrate our commitment to Medicare Advantage and our confidence in the long-term future of the program than the transaction we are announcing today, said Herb Fritch, chairman/CEO of Nashville-based HealthSpring. "This acquisition will extend HealthSpring's reach into new geographies, including an immediate and sizable presence in the Philadelphia market. With diversified geography and increased membership scale, the combined companies will be even better positioned in the new environment created by health insurance reform."
Jeff Folick, CEO/chairman of Baltimore-based Bravo Health, called the acquisition "the right next step for our company, and we are fortunate to be aligning ourselves with an organization that is so similar to ours."
HealthSpring already owns and operates Medicare Advantage plans in Alabama, Florida, Georgia, Illinois, Mississippi, Tennessee, and Texas and also has a national stand-alone Medicare prescription drug plan.
The deal will be financed with unrestricted cash and borrowings under an amended revolving credit facility and new term loan facilities that will be established simultaneously with the closing of the transaction. HealthSpring has entered into a $750 million financing commitment with JPMorgan Chase Bank, N.A.; Bank of America Merrill Lynch; and Raymond James Bank, FSB. The commitment consists of an amendment to HealthSpring's existing $350 million credit facility combined with $400 million of new loans.
The deal is expected to close by the end of the year and should add $.45 to $.55 to HealthSpring's 2011 earnings per share. HealthSpring expects that transaction expenses, including financing commitment, financial advisory, and other fees, will impact 2010 earnings by about $.20. The transaction does not need HealthSpring stockholders' approval, but is subject to federal and state regulatory approvals.
The Centers for Medicare & Medicaid this week reminded healthcare providers, health plans, clearinghouses, and vendors about looming compliance deadlines for new diagnosis and procedure codes, and updated standards for electronic healthcare transactions.
The first compliance milestone for the Accredited Standards Committee X12 Technical Reports Type 3, Version 005010 (Version 5010) electronic healthcare transaction standards begins on Jan. 1, 2011. By then, HIPAA-covered entities should be ready to test the functionality of practice management and related software featuring Version 5010 standards.
Use of the Version 5010 standards for HIPAA electronic healthcare transactions, including claims, remittance advice, eligibility inquiries, referral authorization, and other administrative transactions, becomes mandatory on Jan. 1, 2012. Version 5010 standards also provide the framework for ICD-10-CM and ICD-10-PCS revised medical data code sets that must be in place on Oct. 1, 2013.
"The Version 5010 standards and ICD-10 codes are necessary steps to facilitate the national transition to an electronic healthcare environment," says CMS Administrator Donald Berwick, MD. "Transitioning to the Version 5010 transaction standards in 2012 and to the ICD-10 codes in 2013 will help accelerate the widespread adoption of health information technology and move the nation toward a more efficient, quality-focused healthcare system."
The expanded ICD-10 code sets will support quality reporting, pay-for-performance, bio-surveillance, and other critical activities, and provide terminology for electronic health records. The ICD-10 code sets will also link to the standards and certification criteria for demonstrating meaningful use of certified EHR technology under the Medicare/Medicaid EHR incentive program.
"We have many information resources and outreach activities in place to facilitate compliance with both Version 5010 and ICD-10, and we are proactively working with partner organizations to ease the transition," says Marilyn Tavenner, CMS principal deputy administrator, "Beginning January 2011, the Medicare Fee for Service program will be ready to test Version 5010 transaction standards with its external partners, and we anticipate that other industry segments will be poised to follow suit."
Also facing a Jan. 1, 2012 installation deadline is the National Council for Prescription Drug Programs Version D.0 standard for retail pharmacy transactions, and NCPDP Version 3.0, the standard for the Medicaid pharmacy subrogation transaction. Small health plans have an additional year and must be compliant with Version 3.0 on Jan. 1, 2013.
To help healthcare providers, health plans, clearinghouses, and vendors work toward the compliance dates for Version 5010 and ICD-10—and avoid delays in claims processing and payment—CMS has been conducting ongoing industry outreach and education, and, most notably, has revised its ICD-10 Web site.
"We have refocused our efforts on making available a full range of resources, including fact sheets, timelines, videos and other materials, at our ICD-10 Web site," says Tony Trenkle, Director of CMS' Office of E-Health Standards and Services.
"All of the information is free and can be downloaded. We have also worked closely with our industry and stakeholder partners to push out important messages through their respective communications vehicles, and we have identified their Version 5010/ICD-10 materials and provided links to their publically accessible Web sites."
The University of Southern Nevada and St. Rose Dominican Hospitals have created an Accelerated Bachelor's Degree in Nursing program that will allow applicants who've already earned a bachelor's degree to become an RN after 14 months of additional study.
The USN program combines online courses and on-site labs taught by USN faculty with clinical rotations at St. Rose facilities and other clinical sites in Southern Nevada.
"Our three hospitals are well-known for providing quality, compassionate healthcare for the community, and our nurses are one of the main reasons we are able to provide that high level of care," says Rod A. Davis, president/CEO of St. Rose Dominican Hospitals. "We are looking forward to working with the USN College of Nursing to provide this much needed educational resource to our community."
The Nevada Department of Employment, Training and Rehabilitation has estimated that nearly 5,500 new nurses will be needed statewide by 2016. Over the next few years, it is anticipated that the nursing occupation will grow by 37%, with an average annual growth rate of 3%, offering employment possibilities in a state now mired with a 14.2% unemployment rate, the highest in the nation.
As the economy improves, it is expected that the demand for nurses will increase. Nurses who delayed retirement during the economic downturn will retire. Part-time nurses who went full-time because of an unemployed or underemployed spouse will resume their part time schedules, and patients will seek treatment for elective procedures they postponed to save out-of-pocket expenses. In addition, healthcare reform and an aging baby boomer generation will create increased demand for nurses for an already stressed national healthcare system that will be short one million nurses by 2020.
The program curriculum focuses on clinical areas including medical surgical, obstetrics, mental-community health, maternal-newborn, and pediatrics nursing.
St. Rose Dominican Hospitals is affiliated with Adrian Dominican Sisters and Catholic Healthcare West. With three hospitals—Rose de Lima, Siena, and San Martin—St. Rose Dominican is the only not-for-profit, religiously sponsored hospital system in Las Vegas.
Louisville, KY-based Kindred Healthcare, Inc. announced plans to acquire five long-term acute care hospitals in Southern California, and three nursing homes in Dallas-Fort Worth in two separate cash deals totaling $218 million this week.
Kindred will pay $180 million to Rancho Cucamonga, CA-based Vista Healthcare, LLC, for the four freestanding hospitals and one hospital-in-hospital with a total of 250 beds. The assets generate annual revenues of approximately $150 million and earnings before interest, income taxes, depreciation and amortization of approximately $27 million.
"We view the Vista transaction as a great opportunity to meet the growing demand for our services in southern California and expand our hospital operations,” Kindred CEO Paul J. Diaz says. “The Vista hospitals also provide several clinical service offerings not currently available in our area hospitals providing us with an opportunity to expand our clinical services as well as attract more commercial and managed care business.”
Vista President/CEO Ara Tavitian, MD, says the combined strengths of the two companies “will promote expanded services and clinical programs that will better serve our patients and their families.
Kindred also offers our employees the ability to expand their opportunities with a proven and dynamic healthcare provider. We look forward to integrating our operations with Kindred and to the continued growth and development of our combined services."
Kindred will also pay $38 million for three recently constructed nursing and rehabilitation centers in the Dallas-Fort Worth market, where Kindred already operates six hospitals and is developing a co-located hospital-based subacute unit. Kindred intends to develop two of the nursing centers into transitional care centers, focused on short-term rehabilitation and medically complex patients, and add a transitional care unit to the third nursing center.
These three nursing and rehabilitation centers have 405 beds and annual revenues of $24 million and EBITDA of $3 million.
“The nursing and rehabilitation center transaction offers us the opportunity to acquire three relatively new, owned facilities and develop them into transitional care centers to complement our existing hospital services in the Dallas-Fort Worth cluster market, where we currently operate six hospitals,” Diaz says. “This transaction also allows us to continue to add to our owned real property base.”
Both acquisitions are subject to regulatory approval and are expected to close this year. Kindred will finance both deals from its revolving credit facility, but the company is not acquiring the capital, or assuming liabilities in either deal.
In the year immediately following the transactions, Kindred said it expects to incur transition costs of between $6 million to $8 million.
Rio Grande Regional Hospital in McAllen, TX, has been given a Level III trauma designation from the Texas Department of State Health Services—becoming one of only four hospitals in South Texas to receive certification for this level of care, the HCA Gulf Coast Division affiliate announced.
"Rio Grande Regional Hospital is already known for its excellent trauma care and our commitment to pursuing excellence in care," said Greg Seiler, CEO of the 320-bed acute care hospital. "By receiving the Level III designation, we continue to meet the needs of our growing community by providing quality trauma intervention and treatment."
Trauma surgeons and hospital staff are available 24 hours a day at the hospital. Specially trained nurses attend each trauma patient throughout the day for care advancement and coordination. Trauma data is collected and entered into a registry database for quality improvement and injury prevention initiatives. The trauma coordinator provides trauma education throughout the hospital.
HCA affiliated facilities in the Gulf Coast Division include 12 hospitals, seven ambulatory surgery centers, four free standing emergency centers, five imaging centers, five cancer care programs and a Regional Transfer Center. The Regional Transfer Center provides ground and air patient transportation to and from any HCA Houston Affiliated Hospital and any other healthcare facilities.
